In spite of growing interest in understanding the association between the social

determinants of health and health outcomes, for a long time many academics, policy
makers, elected officials, and others were reluctant to identify racism as one of the root
causes of racial health inequities. [17] To date, many of the studies conducted to
investigate the effect of racism on health have focused mainly on interpersonal racial
and ethnic discrimination, with comparatively less emphasis on investigating the health
outcomes of structural racism.[18] The latter involves interconnected institutions whose
linkages are historically rooted and culturally reinforced. [19] In the context of the COVID-
19 pandemic, acts of discrimination are taking place in a variety of contexts (for
example, social, political, and historical). In some ways, the pandemic has exposed
existing racism and discrimination.

Poverty (low-wage jobs, insurance coverage, homelessness, and jails and prisons)

Data drawn from the 2018 Current Population Survey to assess the characteristics of
low-income families by race and ethnicity shows that of the 7.5 million low-income
families with children in the United States, 20.8% were black or African American (while
their percentage of the population in 2018 was only 13.4%). [20] Low-income racial and
ethnic minorities tend to live in densely populated areas and multigenerational
households. These living conditions make it difficult for low-income families to take
necessary precautions for their safety and the safety of their loved ones on a regular
basis.[21] This fact becomes even more crucial during a pandemic.

Low-wage jobs: The types of work where people in some racial and ethnic groups are
overrepresented can also contribute to their risk of getting sick with COVID-19. Nearly
40% of African American workers, more than seven million, are low-wage workers and
have jobs that deny them even a single paid sick day. Workers without paid sick leave
might be more likely to continue to work even when they are sick. [22] This can increase
workers’ exposure to other workers who may be infected with the COVID-19 virus.